NCPCA materials make it clear that parents should never spank their children, stating that: "No child needs a spanking, spanking can be dangerous . . . children do not need to be hit in order to learn how to behave."

It is unlikely that all those being screened as possibly "at risk" have given informed consent. Some consent forms are part of the hospital admission procedure and can be misunderstood. Some women are approached for consent while in labor. In addition, because assessment workers (who have reviewed the medical records) hold intimate information about the women they are soliciting, the voluntary nature of the program is suspect.

Home visitors in many states are told to inform authorities if "imminent harm" to children is "suspected." Parents have been reported for spanking and even for "raising their voices."

All data are entered into a national database.

HFA programs are often put into place stealthily. Some states have passed legislation that will enable home visitation statewide, with wording that is so benign and sandwiched in between other issues that it appears totally innocuous without in-depth analysis.

The Parents as Teachers (PAT) program, which began in Missouri as a sincere attempt to help "at risk" families, is now described as the "first cousin" to HFA. PAT also is being used as a model for child abuse intervention home visitation programs.

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